Title: Utilization Review Medical Nurse – BCBA
Duration: 6 Months+ CTH
Location: Baltimore, MD (Remote Job)
W2 Rate: $52/hr.
Essential Functions:
Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health.
Job Purpose:
Utilizing key principles of utilization management the Utilization Review Specialist (BCBA Licensee) performs prospective, concurrent, and retrospective reviews to determine authorization, medical necessity, and appropriateness of ABA services.
The Utilization Management Specialist leverages clinical expertise in behavior analysis, evidence-based ABA practices, and critical thinking skills to evaluate treatment plans, service intensity, and clinical outcomes. This role analyzes clinical documentation, benefit plans, mandates, and medical/behavioral health policies to support determinations related to ABA services for individuals with Autism Spectrum Disorder and other developmental or behavioral diagnoses.
Required Experience:
Minimum 3–5 years of clinical ABA experience, including development and supervision of ABA treatment programs
Licensure/Certification
Board Certified Behavior Analyst (BCBA) – Required
Active state licensure as a Behavior Analyst (if applicable in practicing state) – Required
Preferred Experience:
Prior experience in utilization management, care management, or payer-side review of ABA services
Working knowledge of managed care and health delivery systems
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